SynthesisThe Cochrane database of systematic reviews2004
Hypertonic versus near isotonic crystalloid for fluid resuscitation in critically ill patients.
Synthesis in The Cochrane database of systematic reviews, 2004. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 6 syntheses or guidelines pooled it, 147 citations in OpenAlex.
- Wound, Pressure Ulcer, and Burn Guidelines (2023)-6: Guidelines for the Management of Burns, Third Edition.The Journal of dermatology · 2026Guideline
- Prehospital coagulation management and fluid replacement therapy in patients with multiple and/or severe injuries - A systematic review and clinical practice guideline update.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Pooled it
- European Society of Intensive Care Medicine clinical practice guideline on fluid therapy in adult critically ill patients. Part 1: the choice of resuscitation fluids.Intensive care medicine · 2024Guideline
- The effectiveness of prehospital hypertonic saline for hypotensive trauma patients: a systematic review and meta-analysis.BMC emergency medicine · 2017Pooled it
- Hypertonic salt solution for peri-operative fluid management.The Cochrane database of systematic reviews · 2016Pooled it
- Stereotactic aspiration versus craniotomy for primary intracerebral hemorrhage: a meta-analysis of randomized controlled trials.PloS one · 2014Pooled it
- Effectiveness of road safety interventions: An evidence and gap map.Campbell systematic reviews · 2024Article
- Postinjury Inflammation and Organ Dysfunction.Critical care clinics · 2017Review
- Fluid resuscitation in haemorrhagic shock in combat casualties.Disaster and military medicine · 2017Review
- Randomization methods in emergency setting trials: a descriptive review.Research synthesis methods · 2016Review
- Immunomodulatory effect of hypertonic saline in hemorrhagic shock.Daru : journal of Faculty of Pharmacy, Tehran University of Medical Sciences · 2015Review
- [Fluid resuscitation in hemorrhage].Der Anaesthesist · 2014Review
- Effect of hypertonic saline on hypotension following induction of general anesthesia: A randomized controlled trial.Advanced biomedical research · 2014Article
- Clinical review: the critical care management of the burn patient.Critical care (London, England) · 2013Review
- [Increased intracranial pressure and brain edema].Der Anaesthesist · 2013Review
- [Increased intracranial pressure and brain edema].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2013Review
- In vitro impairment of whole blood coagulation and platelet function by hypertonic saline hydroxyethyl starch.Scandinavian journal of trauma, resuscitation and emergency medicine · 2011Article
- Advances in resuscitation strategies.International journal of surgery (London, England) · 2011Review
- The role of pre-hospital blood gas analysis in trauma resuscitation.World journal of emergency surgery : WJES · 2010Article
- Use of albumin as a risk factor for hospital mortality among burn patients in Brazil: non-concurrent cohort study.Sao Paulo medical journal = Revista paulista de medicina · 2010Article
Corrections and comments
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Authors and funding
4 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundHypertonic solutions are considered to have a greater ability to expand blood volume and thus elevate blood pressure and can be administered as a small volume infusion over a short time period. On the other hand, the use of hypertonic solutions for volume replacement may also have important disadvantages.
objectivesTo determine whether hypertonic crystalloid decreases mortality in patients with hypovolaemia. SEARCH STRATEGY: We searched MEDLINE, EMBASE, The Cochrane Controlled Trials Register and the specialised register of the Cochrane Injuries Group. We checked reference lists of all articles identified and searched the National Research Register. SELECTION CRITERIA: Randomised trials comparing hypertonic to isotonic and near isotonic crystalloid in patients with trauma, burns or undergoing surgery. DATA COLLECTION AND ANALYSIS: Two authors independently extracted the data and assessed the quality of the trials. MAIN
resultsFourteen trials with a total of 956 participants are included in the meta-analysis. The pooled relative risk (RR) for death in trauma patients was 0.84 (95% confidence interval [CI] 0.69-1.04); in patients with burns 1.49 (95% CI 0.56-3.95); and in patients undergoing surgery 0.51 (95% CI 0.09, 2.73). In the one trial that gave data on disability using the Glasgow outcome scale, the relative risk for a poor outcome was 1.00 (95% CI 0.82, 1.22). REVIEWERS'
conclusionsThis review does not give us enough data to be able to say whether hypertonic crystalloid is better than isotonic and near isotonic crystalloid for the resuscitation of patients with trauma, burns, or those undergoing surgery. However, the confidence intervals are wide and do not exclude clinically significant differences. Further trials which clearly state the type and amount of fluid used and that are large enough to detect a clinically important difference are needed.
Indexed as
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.